Provider Demographics
NPI:1649022419
Name:VENKATARAMAN, SHYAM SUNDAR
Entity type:Individual
Prefix:
First Name:SHYAM SUNDAR
Middle Name:
Last Name:VENKATARAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19611 PECOS BEND CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6441
Mailing Address - Country:US
Mailing Address - Phone:832-674-6700
Mailing Address - Fax:
Practice Address - Street 1:2520 RESEARCH FOREST DR STE 400
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-4274
Practice Address - Country:US
Practice Address - Phone:936-283-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center